A 52-year-old man reports brief episodes of vertigo when turning over in bed. Supine roll testing evokes horizontal nystagmus that beats toward the lowermost ear and reverses direction when he rolls to the other side. Which variant of BPPV and its standard repositioning treatment are correct?

• A Posterior canal canalithiasis, treated with the Epley manoeuvre
• B Horizontal canal canalithiasis, treated with the barbecue roll (Lempert) manoeuvre ✓
• C Anterior canal canalithiasis, treated with the deep head hanging manoeuvre
• D Horizontal canal cupulolithiasis, treated with the Semont liberatory manoeuvre

Explanation

Geotropic horizontal nystagmus on supine roll testing, beating toward the dependent ear, indicates canalithiasis of the lateral semicircular canal, the second most common BPPV variant. It is treated with the barbecue roll (Lempert) manoeuvre or the Gufoni manoeuvre. Posterior canal BPPV produces torsional upbeating nystagmus on Dix-Hallpike and is treated by Epley. Apogeotropic nystagmus would suggest cupulolithiasis of the horizontal canal.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.